Osteoporosis International

, Volume 21, Issue 11, pp 1817–1824 | Cite as

Bone health and deterioration in quality of life among participants from the Hertfordshire cohort study

  • E. M. DennisonEmail author
  • K. A. Jameson
  • H. E. Syddall
  • H. J. Martin
  • J. Cushnaghan
  • A. Aihie Sayer
  • C. Cooper
Original Article



We utilised the Hertfordshire cohort study to examine relationships between bone density at baseline and SF-36 status 4 years later. We found deterioration in the mental health domain over follow-up in osteoporotic men (but not women) compared with other groups (relative rate ratio = 5.78, 95% confidence interval (CI) 1.78–19.2).


Osteoporosis is associated with decreased quality of life, although it has been difficult to evaluate the confounding effects of fracture and co-morbidity. Having previously shown that male osteoporotics have poorer health than counterparts with normal bone mineral density, even after adjustment for co-morbidity and prior fracture, we assessed quality of life in both groups 4 years apart.


Four hundred and ninety-eight men and 468 women completed questionnaires detailing lifestyle factors, co-morbidities and quality of life (SF-36) before undergoing bone density measurements at the lumbar spine and total femur. At follow-up 4 years later, 322 men and 320 women were reassessed.


Multinomial logistic regression confirmed deterioration in mental health over follow-up in osteoporotic men compared with other groups (relative rate ratio = 5.78, 95% CI 1.78–19.2). These patterns were not apparent among women.


Men with lower bone density at baseline had poorer quality of life some 4 years later, even after adjustment for co-morbidity and fracture. This may reflect secondary osteoporosis in men (due to alcohol or hypogonadism).


Bone Men Osteoporosis Quality of life Women 



We thank the men and women who participated in the study, the General Practitioners who allowed access to their patients and the nurses and radiology staff who administered the bone density measurements. Computing support was provided by Vanessa Cox.


This study was supported by grants from the Medical Research Council and Arthritis Research Campaign.

Conflicts of interest



  1. 1.
    Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841CrossRefPubMedGoogle Scholar
  2. 2.
    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK, Cannata JB, Eastell R, Felsenberg D, Gennari C, Johnell O, Kanis JA, Kiss C, Masaryk P, Naves M, Poor G, Raspe H, Reid DM, Reeve J, Stepan J, Todd C, Woolf AD, O'Neill TW (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119CrossRefPubMedGoogle Scholar
  3. 3.
    Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA, Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S, Joyce C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA (2003) The association between osteoporotic fractures and health-related quality of life as measured by the health utilities index in the Canadian multicentre osteoporosis study. Osteoporos Int 14:895–904CrossRefPubMedGoogle Scholar
  4. 4.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392CrossRefPubMedGoogle Scholar
  5. 5.
    Silverman SL, Minshall ME, Shen W, Harper KD, Xie S (2001) The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the multiple outcomes of raloxifene evaluation study. Arthritis Rheum 44:2611–2619CrossRefPubMedGoogle Scholar
  6. 6.
    Yoh K, Tanaka K, Ishikawa A, Ishibashi T, Uchino Y, Sato Y, Tobinaga M, Hasegawa N, Kamae S, Yoshizawa M (2005) Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment. J Bone Miner Metab 23:167–173CrossRefPubMedGoogle Scholar
  7. 7.
    Dhillon V, Hurst N, Hannan J (2005) Association of low general health status, measured prospectively by Euroqol EQ5D, with osteoporosis, independent of a history of prior fracture. Osteoporos Int 16:483–489CrossRefPubMedGoogle Scholar
  8. 8.
    Picavet HSJ, Hoeymans N (2004) Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 63:723–729CrossRefPubMedGoogle Scholar
  9. 9.
    Martin AR, Sornay-Rendu E, Chandler JM, Duboeuf F, Girman CJ, Delmas PD (2002) The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 31:32–36CrossRefPubMedGoogle Scholar
  10. 10.
    Romagnoli E, Carnevale V, Nofroni I, D'Erasmo E, Paglia F, De Geronimo S, Pepe J, Raejntroph N, Maranghi M, Minisola S (2004) Quality of life in ambulatory postmenopausal women: the impact of reduced bone mineral density and subclinical vertebral fractures. Osteoporos Int 15:975–980CrossRefPubMedGoogle Scholar
  11. 11.
    Dennison EM, Syddall HE, Statham C, Aihie Sayer A, Cooper C (2006) Relationships between SF-36 health profile and bone mineral density: the Hertfordshire cohort study. Osteoporos Int 17:1435–1442CrossRefPubMedGoogle Scholar
  12. 12.
    Syddall HE, Aihie Sayer A, Dennison EM, Martin HJ, Barker DJP, Cooper C (2005) Cohort profile: the Hertfordshire cohort study. Int J Epidemiol 34:1234–1242CrossRefPubMedGoogle Scholar
  13. 13.
    Dallosso HM, Morgan K, Bassy EJ, Ebrahim SBJ, Fentem PH, Arie THD (1988) Levels of customary physical activity among the old and very old living at home. J Epidemiol Community Health 42:121–127CrossRefPubMedGoogle Scholar
  14. 14.
    Prineas RJ, Crow RS, Blackburn H (1982) The Minnesota code manual of elecrocardiographic findings: standards and procedures for measurement and classification. John Wright, BostonGoogle Scholar
  15. 15.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553CrossRefPubMedGoogle Scholar
  16. 16.
    Ware JE, Kosinski M, Gandek B (2000) SF-36 health survey: manual and interpretation guide. Quality Metric Incorporated, LincolnGoogle Scholar
  17. 17.
    Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the Sf-36. J Health Econ 21:271–292CrossRefPubMedGoogle Scholar
  18. 18.
    Rohde G, Haugeberg G, Mengshoel AM, Moum T, Wahl AK (2008) Is global quality of life reduced before fracture in patients with low-energy wrist or hip fracture? A comparison with matched controls. Health Qual Life Outcomes 6:90CrossRefPubMedGoogle Scholar
  19. 19.
    Cooper C, Jakob F, Chinn C, Martin-Mola E, Fardellone P, Adami S, Thalassinos NC, Melo-Gomes J, Torgerson D, Gibson A, Marin F (2008) Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). Osteoporos Int 19:493–501CrossRefPubMedGoogle Scholar
  20. 20.
    Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, Brown JP, Josse RG, Kaiser S, Anastassiades T, Goltzman D, Papadimitropoulos M, Tenenhouse A, Prior JC, Olszynski WP, Adachi JD (2008) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714CrossRefPubMedGoogle Scholar
  21. 21.
    de Oliveira FN, Arthuso M, da Silva R, Orcesi Pedro A, Mendes Pinto Neto A, Costa-Paiva L (2009) Quality of life in women with postmenopausal osteoporosis: correlation between QUALEFFO 41 and SF-36. Maturitas 62:85–90CrossRefGoogle Scholar
  22. 22.
    Pasco JA, Henry MJ, Korn S, Nicholson GC, Kotowicz MA (2009) Morphometric vertebral fractures of the lower thoracic and lumbar spine, physical function and quality of life in men. Osteoporos Int 20:787–792CrossRefPubMedGoogle Scholar
  23. 23.
    Sogaard AJ, Meyer HE, Falch J (2003) The Oslo Health Study: to get the diagnosis osteoporosis—consequence on self-reported health. Osteoporos Int 14(Suppl 2):S20Google Scholar
  24. 24.
    Kessenich CR, Guyatt GH, Rosen CJ (1998) Health-related quality of life and participation in osteoporosis clinical trials. Calcif Tissue Int 62:189–192CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • E. M. Dennison
    • 1
    Email author
  • K. A. Jameson
    • 1
  • H. E. Syddall
    • 1
  • H. J. Martin
    • 1
  • J. Cushnaghan
    • 1
  • A. Aihie Sayer
    • 1
  • C. Cooper
    • 1
    • 2
  1. 1.MRC Epidemiology Resource CentreUniversity of Southampton, Southampton General HospitalSouthamptonUK
  2. 2.Botnar Research CentreInstitute of Musculoskeletal Sciences, University of OxfordOxfordUK

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